Aortic Intramural Hematoma and Its Complications

Alomari, Ihab; Hamirani, Yasmin S.; Madera, George; Tabe, Cyril; Akhtar, Nila J.; Raizada, Veena

doi:10.1161/circulationaha.113.001809

Cited by 68 publications

(66 citation statements)

References 17 publications

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“…1C). This unusual presentation is related to iatrogenic bleeding within the media, and might lead to aortic wall weakening with a high risk of outward aortic rupture, as described by Alomari et al 29 in a different setting of spontaneous parietal aortic hematoma. CT angiography performed 2 days after the index procedure revealed extension of the dissection 35 mm into the ascending aorta; however, this patient had the shortest duration of hospitalization (5 days) and CT angiography was not repeated before discharge.…”

Section: Discussionmentioning

confidence: 81%

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Boukhris¹,

Tomasello²,

Marzà³

et al. 2015

Canadian Journal of Cardiology

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Section: Discussionmentioning

confidence: 81%

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Boukhris¹,

Tomasello²,

Marzà³

et al. 2015

Canadian Journal of Cardiology

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“…It results from spontaneous rupture of aortic vasa vasorum or penetrating atherosclerotic ulcer [10-12]. Recent advances in noninvasive imaging such as computed tomography (CT), magnetic resonance (MR) imaging, and transesophageal echocardiography (TEE) are used to identify a variant of aortic dissection and have further emphasized the importance of early diagnosis of acute aortic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns and their outcomes of acute aortic intramural hematoma in real world: multicenter registry for aortic intramural hematoma

Choi

Son

Lee

et al. 2014

BMC Cardiovasc Disord

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BackgroundIntramural hematoma of the aorta (IMH), a variant of classic aortic dissection, shows very dynamic process in the early phase. The aim of this study is to evaluate clinical outcomes of patients with acute aortic IMH from real world registry data.MethodsWe analyzed 165 consecutive patients with acute IMH from five medical centers in Korea. All patients were divided into two groups; type A (n = 61, 37.0%) and type B (n = 104, 63.0%) according to the Stanford classification. Clinical outcomes and morphological evolution by CT were analyzed for 2 years.ResultsMost of the patients (77.0% of type A and 99.0% of type B, P < 0.001) were treated medically during their initial hospitalization. There were no significant differences in in-hospital mortality (4.9% vs. 2.9%, P = 0.671) and 2-year mortality (13.1% vs. 11.5%, P = 0.765) between two groups. During the 2-year follow up period, progression to aortic dissection (18.0% vs. 6.7%, P = 0.037) and surgical treatment (29.5% vs. 2.9%, P < 0.001) were higher in type A. For the type A patients, there were no significant difference in in-hospital mortality (7.1% of surgery vs. 4.3% of medical, P = 0.428) and 2-year mortality (7.1% of surgery vs. 14.9% of medical, P = 0.450) in terms of initial treatment strategy.ConclusionFor real world practice in Korea, most of IMH patients were treated medically at presentation and showed favorable outcomes. Thus, even in type A acute IMH, early medical treatment with alternative surgical conversion for selected, complicated cases would be a favorable treatment option.

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“…Historically, IMH has been thought to result from hemorrhage of the vasa vasorum into the aortic wall, although this has not been clearly established. IMH appears on CT as a crescentic high-attenuation rim along the aorta which does not enhance after the administration of contrast [20]. Non-contrast images are important for the identification of IMH which may be otherwise difficult to distinguish from opacified lumen or focal small dissection.…”

Section: Intramural Hematomamentioning

confidence: 99%

Role of Computed Tomography in Assessment of the Thoracic Aorta

Meyersohn

Ghemigian

Shapiro

et al. 2015

Curr Treat Options Cardio Med

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Thoracic aortic disease is increasing in prevalence and can result in serious morbidity and mortality. Computed tomography (CT) angiography is an important imaging modality for assessment of thoracic aortic pathology due to wide availability, rapid acquisition, reproducibility, superior spatial and temporal resolution, and capability for 3D image post-processing. CT is the preferred imaging modality in the acute setting to rapidly identify patients with acute aortic syndromes including dissection, intramural hematoma, and penetrating aortic ulcer. CT also plays an important role in post-procedural surveillance of the thoracic aorta for early and late complications from open or endovascular repair. Incidentally detected thoracic aortic aneurysms and congenital aortic anomalies such as coarctation can be thoroughly characterized and followed over time for potential elective intervention. Drawbacks of CT include exposure to radiation and iodinated contrast media; however, recent strategies for dose reduction and contrast optimization have significantly decreased these risks. Electrocardiogram (ECG)-gated CT angiography provides additional information about the aortic root, coronary arteries, and other cardiac structures without motion artifacts.

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Aortic Intramural Hematoma and Its Complications

Cited by 68 publications

References 17 publications

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Iatrogenic Aortic Dissection Complicating Percutaneous Coronary Intervention for Chronic Total Occlusion

Treatment patterns and their outcomes of acute aortic intramural hematoma in real world: multicenter registry for aortic intramural hematoma

Role of Computed Tomography in Assessment of the Thoracic Aorta

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